AAPC CASES CPMA REVIEW-CASE 1
30 Exam Updated ACTUAL QUESTIONS
AND CORRECT ANSWERS
You are performing an audit of evaluation and management services for a family practice
office. In the encounter, you read the physician ordered and reviewed a differential WBC.
Which of the following best describes what you would expect to see in the medical record? -
CORRECT ANSWER Patient identification, assignment of benefits, patient's medical
history, immunizations, physical examination, lab report, clinical impression, and physician
orders.
As an auditor, who of the following would NOT be expected to submit operative notes? -
CORRECT ANSWER Surgical assistants
A provider knows that an evaluation and management service they provide on the same date
as a major procedure will be bundled, so he submits the claim for the E/M with a different
date of service. This is an example of: - CORRECT ANSWER Fraud
In preparation for a high volume of patients coming in for chemotherapy, the nurse
documents the chemotherapy treatments in advance. The purpose is to speed up the treatment
process so patients do not have to wait long. Would this cause concern in an audit? -
CORRECT ANSWER Yes, chart entry should not be made in advance of the treatment.
Patients can request copies of disclosure of PHI under HIPAA: - CORRECT
ANSWER For a six (6) year period of time
SOAP and CHEDDAR are two formats of medical record documentation. Which section of
each format would you find the patient's history? - CORRECT ANSWER S in SOAP
and C in CHEDDAR
When must ABNs be signed? - CORRECT ANSWER Far enough in advance that the
beneficiary or representative has time to consider the options and make an informed choice
, What is the appropriate way to dispose of PHI that is no longer needed? - CORRECT
ANSWER Discard it in a locked shredding receptacle
Which of the following would NOT be expected to fall under the responsibility or oversight
of an organization's compliance committee? - CORRECT ANSWER C.
Recommending a specific merit increase in pay for employee's adherence to the code of
conduct
A family physician requests a post payment audit on claims from a particular commercial
payer from which he is receiving denials. Whenever the provider performs a minor procedure
with an E/M service, the minor surgery is reimbursed but the E/M service is denied. You
review 10 charts and all cases are documented and coded correctly. What could be the reason
for the denial? - CORRECT ANSWER D. The provider may be excluded from
Medicare for submitting fraudulent claims.
Which type of case is not prosecuted under the federal false claims act? - CORRECT
ANSWER A. Physician tax issues
What are the recommended number of charts to audit per provider and the minimum
frequency of the audit? - CORRECT ANSWER C. 10 records per provider each year
How is RAT-STATS used by an auditor? - CORRECT ANSWER B. Software used in
performing statistical random samples and evaluating results
A comprehensive audit is: - CORRECT ANSWER A. A large number of claims are
selected for a review that might be focused on specific procedure and/or diagnosis codes.
According to the 2017 _________, the OIG will review Medicare Part B payments for
prolonged services to determine whether the payments were made according to Medicare
requirements. - CORRECT ANSWER B. OIG Work Plan
Commercial and Government carriers audit medical records. Select the statement that is true
regarding commercial and government carriers. - CORRECT ANSWER B.
30 Exam Updated ACTUAL QUESTIONS
AND CORRECT ANSWERS
You are performing an audit of evaluation and management services for a family practice
office. In the encounter, you read the physician ordered and reviewed a differential WBC.
Which of the following best describes what you would expect to see in the medical record? -
CORRECT ANSWER Patient identification, assignment of benefits, patient's medical
history, immunizations, physical examination, lab report, clinical impression, and physician
orders.
As an auditor, who of the following would NOT be expected to submit operative notes? -
CORRECT ANSWER Surgical assistants
A provider knows that an evaluation and management service they provide on the same date
as a major procedure will be bundled, so he submits the claim for the E/M with a different
date of service. This is an example of: - CORRECT ANSWER Fraud
In preparation for a high volume of patients coming in for chemotherapy, the nurse
documents the chemotherapy treatments in advance. The purpose is to speed up the treatment
process so patients do not have to wait long. Would this cause concern in an audit? -
CORRECT ANSWER Yes, chart entry should not be made in advance of the treatment.
Patients can request copies of disclosure of PHI under HIPAA: - CORRECT
ANSWER For a six (6) year period of time
SOAP and CHEDDAR are two formats of medical record documentation. Which section of
each format would you find the patient's history? - CORRECT ANSWER S in SOAP
and C in CHEDDAR
When must ABNs be signed? - CORRECT ANSWER Far enough in advance that the
beneficiary or representative has time to consider the options and make an informed choice
, What is the appropriate way to dispose of PHI that is no longer needed? - CORRECT
ANSWER Discard it in a locked shredding receptacle
Which of the following would NOT be expected to fall under the responsibility or oversight
of an organization's compliance committee? - CORRECT ANSWER C.
Recommending a specific merit increase in pay for employee's adherence to the code of
conduct
A family physician requests a post payment audit on claims from a particular commercial
payer from which he is receiving denials. Whenever the provider performs a minor procedure
with an E/M service, the minor surgery is reimbursed but the E/M service is denied. You
review 10 charts and all cases are documented and coded correctly. What could be the reason
for the denial? - CORRECT ANSWER D. The provider may be excluded from
Medicare for submitting fraudulent claims.
Which type of case is not prosecuted under the federal false claims act? - CORRECT
ANSWER A. Physician tax issues
What are the recommended number of charts to audit per provider and the minimum
frequency of the audit? - CORRECT ANSWER C. 10 records per provider each year
How is RAT-STATS used by an auditor? - CORRECT ANSWER B. Software used in
performing statistical random samples and evaluating results
A comprehensive audit is: - CORRECT ANSWER A. A large number of claims are
selected for a review that might be focused on specific procedure and/or diagnosis codes.
According to the 2017 _________, the OIG will review Medicare Part B payments for
prolonged services to determine whether the payments were made according to Medicare
requirements. - CORRECT ANSWER B. OIG Work Plan
Commercial and Government carriers audit medical records. Select the statement that is true
regarding commercial and government carriers. - CORRECT ANSWER B.
